Rehabilitation Strategies in patients with Spinal Cord Injuries

ABSTRACTThe setting of rehabilitation for patients with spinal cord injured is promising environment. Attending the new strategies is useful to promote the treatment and the patient's ability. This method has a huge challenge for patients encountered with cognitive impairment. Patient education and skills at the rehabilitation center can be a challenging endeavor. By rehabilitation, patients suddenly evolve and they have to enhance the cognitive capacity to survive environmental changes face dramatic. These proceedings help the independence, self-esteem of the patients and help them cope with illness and life

The Synergistic Effect of Co-delivery of Anticancer Drugs Into Astrocytes Isolated From Human Glioblastoma Multiforme

Background: Chemotherapy drugs are not effective in the treatment of primary brain tumors due to the low efficacy of these drugs and drug transfer from the blood-brain barrier (BBB) toward the tumor site. Our purpose in this study was to assess the co-delivery of anticancer drugs to increase drug permeability from BBB.Methods: In this study, two chemotherapy drugs, namely methotrexate (MTX) and paclitaxel (PTX), were inserted into polyvinyl alcohol and poloxamer188-conjugated nanoparticles (NPs). Astrocytes were treated with different concentrations of 0-50 μg/ml from MTX, PTX, the MTX-PTX mixture, PTX-loaded NPs, MTX-loaded NPs, and PTX-MTX co-loaded NPs for 48 hours. The tumoricidal effect was assessed using the survival rate, Hoechst staining, and western blotting.Results: The results indicated significant reduction of the survival rate in astrocytes treated with PTX-MTX co-loaded NPs. In addition, apoptosis hallmarks consisting of fragmented DNA, overexpression of Bax, and expression reduction of Bcl-2 were in the cultured astrocytes.Conclusions: Our study proposes that the PTX-MTX co-delivery to NPs could be used as a possible approach for anti-cancer drug delivery to glioblastoma multiforme

Entanglement Of The Rights Of The Child, Well-Being And Justice: A Conceptual Framework For Child Protection And Well-Being

Background: Human Rights (HRs) framework supports improving human health status and the reduction of health inequalities through action on Social Determinants of Health (SDH). Given the shortcoming of HRs to protect the children, the question is, how can we ensure child protection and well-being rather than just child health?Methods: In this conceptual analysis study, first, we explain the fundamental rights of the child and the steering role of them in moving towards health equity through action on SDH; second, meanwhile argue the shortcoming of rights-based protection, provide a list of the core capabilities and corresponding rights of the child; and third, we represent a conceptual framework for child protection and well-being using both HRs norms and moral entitlements based on recent ethical theories of justice, with a preventive approach.Results: According to the framework, HRs instruments should lead to the protection of the child and the development of core capabilities through addressing social determinants and providing equal opportunities, of which the ability to live a healthy life is just one. In addition, actualizing these capabilities depends on the context. Since achieving well-being rather than just the health, in addition to acquiring the core capabilities as states of beings, implies their function as doings, that requires considering the socioecological context to provide means necessary to meet the essential dimensions of well-being at the level of adequacy.Conclusion: Implementing the suggested framework requires that each country create a national action framework and determine the role and duties of the responsible organizations

Cut-off Value for Stenosis Ratio and Zung Depression Scale in Successful Prediction of Posterior Spinal Fusion surgery

Background: The aim of this study was to investigate effect of some clinical attributes in prediction of satisfaction with posterior spinal fusion (PSF) surgery in patients with lumbar disc herniation (LDH) and lumbar spinal canal stenosis (LSCS) and determine a cut-off point for these attributes.Methods: The attributes such as stenosis ratio (SR) values (described by Lurencin), Japanese Orthopaedic Association (JOA), The Zung depression scale (ZDS), duration of symptoms (in months), were investigated for 329 patients with LSCS and 151 patients with LDH separately. Patient satisfaction was recorded based on the international standard questionnaire Swiss Spinal Stenosis Score (SSS). The sensitivity and specificity values and the optimal cut-off points were calculated for SR, JOA, ZDS and duration of symptoms using receiver operating characteristic (ROC) analysis.Results: One hundred fifty-one patients with LDH (39 male, 112 female; mean age 50.24 ± 9.21 years) and 329 patients with LSCS (111 male, 218 female; mean age 53.28 ±7.81 years) were followed–up for 6 months. Post-surgical satisfaction was 73.86% in patients with LSCS and 85.43% in patients with LDH. The cut-off point of SR for prediction of besting surgical outcome was estimated more than 0.46 with asymptotic significance less than 0.05, 60% sensitivity and 75% specificity in LSCS patients (AUC-0.705, 95% CI, 0.644–0.766; P < 0.001).Conclusion: The findings show that the SR with a cut off value of 0.46 cross sectional area, in patients with LSCS may be superior to JOA, duration of symptoms and ZDS for prediction of satisfaction with PSF surgery

Pre-Differentiated Embryonic Stem Cell versus Olfactory Ensheathing Cell for Spinal Cord Regeneration after Compressive Injury in Rat

Background: Transplantation approaches are interventions currently available to apply to the devastating problem of spinal cord injury (SCI). Olfactory ensheathing cell (OEC) and embryonic stem cell (ESC) are considered to be promising therapeutic strategies. In this study, we compared the potential use of OECs and neurally pre-differentiated ESCs in contusion spinal cord.Methods: OECs were harvested from olfactory bulb of rats and labeled with Hoescht 33342. ESCs were generated by using feeder free GFP positive CGR8 mouse ESCs and neurally pre-differentiation was induced by retinoic acid (RA) and characterized by different antibodies. SCI was induced by fogarty catheter at T8-T9 level in adult rats. Transplantations were performed 9 days after the injury. Rats were randomly divided into 3 main groups (neurally pre-differentiated ESC, OEC and media as control group). The recovery of gross motor function was evaluated using Basso-Beattie-Bresnahan (BBB) locomotor rating scale on the ninth day post injury and once per week thereafter for 4 weeks after cell transplantation. At 28 days after transplantation, histological assessment including transplanted cell detection in tissue, tissue sparing and myelinated axons was performed.Results: Following transplantation, a significant recovery of hindlimb function according to BBB scale was observed in rats in the transplanted groups compared to control and sham groups (p<0.05). There was no significant difference between transplanted groups four weeks after transplantation. OEC and ESC were found in the tissue after transplantation. In OEC group, many of OECs were detected around and within the cystic cavity that number of these cells was significantly higher in comparison with number of cells in ESC group (p< 0.001).In the site of injury, several cavities were produced that disrupted portions of the gray and white matters. The extent of tissue damage was more severe in the sham and control groups than the other groups. Significantly more spinal tissue was spared in OEC and ESC groups (P < 0.001). No significant difference in percentage of spared tissue was found between sham and control groups or transplanted groups. The percentage of myelinated area was greater in OEC group than in three other groups (p< 0.05) (Figure 5, A). Although the percentage of myelinated area was more in ESC group in comparison with non-treated groups, but this difference was not significant.Conclusion: It seems that using of combination of a myelinating cells like OEC or schwann cell and source of cells to replace dead cells like Mesenchymal or embryonic stem cells, better results can be obtained due to probable synergic effects of these cells

Effectiveness of Autologous Schwann Cell and Bone Marrow-Derived Mesenchymal Stem Cell Transplantation for Individuals With Spinal Cord Injury in Promoting Sensory Recovery

Background: In recent decades, improvement in sensory and motor function after spinal cord injury(SCI) is a major treatment goal. Stem cell therapy has become a promising treatment strategy in theregeneration of central nervous system injuries.Methods: We assessed the effectiveness of autologous Schwann cell (SC) and bone marrow-derivedmesenchymal stem cell (MSC) for individuals with SCI in promoting sensory recovery. Five patientswith a mean ± SD age of 38.80 ± 5.84 years were enrolled in the study. The follow-up course was12 months.Results: We found sensory changes in two patients assessed by the American Spinal InjuryAssociation’s (ASIA’s) impairment scale. Systemic complications were not observed during thecourse of the study.Conclusion: There were no adverse finding after cell transplantation. Also we observed improvementin sensory score in two patients. It seems that the use of this combination of cell therapy may beeffective; but large group studies with control group are required to clarify the effect of either cells

The Effectiveness of TranscranialDirect Current Stimulation (TDCS) on Anxiety, Depression, and Physical Symptoms of People with Chronic Pain

Introduction: Chronic pain and the experience of living with it are unique. Individual perception of pain is affected by physical, psychological, and social variables. This study aimed to determine the effectiveness of transcranial direct current stimulation (tDCS) on anxiety and depression and physical symptoms of patients with chronic pain.Method: This study was a semi-experimental study with pre-test, post-test, and follow-up with the control group. The statistical population of the study included all outpatients of men and women referred to all medical centers in Tehran in 2019 who had received a definitive diagnosis of chronic pain by neurologists, rheumatologists and psychiatrists, and other relevant specialists. The sampling method in this study had two stages: first, through available sampling, selected from several women with a definite diagnosis of chronic pain, and then, based on inclusion criteria and conducting a pre-test session with interviews. A clinical trial conducted by a researcher under the supervision of a psychiatrist based on DSM-5 diagnostic criteria, 30 women (15 for each group) of women who had the highest scores (as baseline) after completion The questionnaires were selected by simple random sampling method and after random allocation, they were replaced in two groups of intervention and control. Data were obtained using the Beck depression questionnaire and the Beck anxiety questionnaire. Repeated variance analysis was used to analyze the data. The above analysis was carried out using SPSS.22 software.Results: The results showed that the effectiveness of transcranial direct current stimulation (tDCS) was effective on anxiety and depression and physical symptoms of people with chronic pain.Conclusion: It can be concluded that transcranial direct current stimulation (tDCS) is effective in reducing anxiety, depression, and physical symptoms of people with chronic pain and can be used to improve psychological problems in people with chronic pain

Assessment of the Microbiome Role in Skin Protection Against UV Irradiation Via Network Analysis

Introduction: Diverse microbiotas which have some contributions to gene expression reside in human skin. To identify the protective role of the skin microbiome against UV exposure, protein-protein interaction (PPI) network analysis is used to assess gene expression alteration.Methods: A microarray dataset, GEO accession number GSE117359, was considered in this respect. Differentially expressed genes (DEGs) in the germ-free (GF) and specific pathogen-free (SPF) groups are analyzed by GEO2R. The top significant DEGs were assigned for network analysis via Cytoscape 3.7.2 and its applications.Results: A total of 28 genes were identified as significant DEGs and the centrality analysis of the network indicated that only one of the seven hub-bottlenecks was from queried genes. The gene ontology analysis of Il6, Cxcl2, Cxcl1, TNF, Il10, Cxcl10, and Mmp9 showed that the crucial genes were highly enriched in the immune system.Conclusion: The skin microbiome plays a significant role in the protection of the skin against UV irradiation and the role of TNF and IL6 is prominent in this regard